Welcome to MSF Field Research

 

MSF is known for its humanitarian medical work, but it has also produced important research based on its field experience. It has published articles in over 100 peer-reviewed journals and they have often changed clinical practice and been used for humanitarian advocacy. These articles are available for free, in full text - no login required. We sincerely thank the publishers for their permission to archive on this site.

 

Published Research and Commentary
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Research Resources

 

  • Enquête de couverture vaccinale multi antigénique Préfecture de Kouroussa

    Ngwa, W; Mupenda, J; Haba, B; Nanan-N'Zeth, K; Bachy, C; Pineda, S (2019-06-25)
    Objectif général Estimer la couverture vaccinale contre la rougeole chez les enfants âgés de 6 mois à 59 mois après la campagne de vaccination de masse appuyée par MSF au mois de décembre 2018 dans la Préfecture de Kouroussa. Décrire la couverture vaccinale par groupe d'âge des antigènes inclus dans le programme national de vaccination du PEV chez les enfants âgées de 6 semaines à 59 mois [BCG, VPO, DTC-Hib-HepB, et fièvre jaune]. Objectifs spécifiques  Estimer le nombre de doses reçues par enfant;  Décrire les raisons de non vaccination;  Décrire les moyens utilisés par la population pour s'informer de la campagne de vaccination. Design Il s’agit d’une enquête transversale en population dans la préfecture de Kouroussa, avec sondage aléatoire en grappe à deux degrés. Population cible La population cible était constituée des enfants de moins de 59 mois résidant dans la Préfecture de Kouroussa. Résultats L’enquête de couverture vaccinale s’est déroulée du 8 au 18 février 2019 dans les 12 sous-préfectures de Kouroussa. Au total 439 ménages et 1.340 enfants âgés de 0 à 59 mois ont été inclus dans l’enquête. Le pourcentage de rétention de la carte de vaccination est faible: 61,6% [95% IC 54,5 – 68,7] pour l’ensemble de l’échantillon. La plupart de l’échantillon est constitué d’enfants de plus de 23 mois [64%]. Le ratio masculin/féminin est de 1,0 Rougeole: couverture vaccinale pour les enfants de 9 mois à 59 mois est de 94,1% [IC=91,5 – 96,6]. Par tranche d’âge, le groupe de 9 mois à 11 mois, est le seul dont la couverture est inférieure à 90%, mais restée supérieure à 85%. Parmi les enfants entre 12 et 23 mois la couverture est 93,5% [IC=89,2 – 97,9]. Les taux de couverture vaccinale, pour les autres différents antigènes2: après analyse, il a été observé que les résultats de la couverture vaccinale [basés sur la déclaration de la mère] chez les enfants âgées de plus de 23 mois risquaient être fortement affectés par le biais de la désirabilité sociale. Par conséquent, les résultats sont présentés comme suit pour BCG, Polio, Penta et Fièvre jaune:  Enfants ≤ 23 mois : couverture vaccinale basée sur la carte de vaccination et les déclarations des mères  Enfants ≥ 24 mois : Couverture vaccinale basée seulement sur la carte de vaccination Parmi les enfants entre 12 et 23 mois, 93% ont reçu une vaccination BCG. Pour Polio et Penta, la première dose de chaque vaccin a été administrée respectivement à plus de 97% et 93% des enfants. Ce taux recule pour n’atteindre que 94% pour la deuxième dose de Polio et 90% pour Penta et entre 91% et 88% pour la troisième dose respectivement. Par rapport à la vaccination contre la fièvre jaune, la couverture est 67% pour les enfants entre 9 mois et 11 mois et 88% pour les enfants entre 12 mois et 23 mois. Chez les enfants âgés de 23 mois, la couverture vaccinale ne prenant en compte que les cartes de vaccination varie de 38% pour la première dose de polio / penta et de 34% pour la troisième dose, 41% pour le BCG et 32% pour la fièvre jaune. Les principales raisons de non-vaccination sont regroupées comme Manque d’opportunité [36,5%], Obstacles [25,9%] et le manque de motivation [20,4%]. Les relais communautaires étaient la source principale d’information [54%] sur la campagne de vaccination de masse contre la rougeole menée par MSF en décembre 2018 Conclusions 1. PEV assez performant. 2. Couverture vaccinale des enfants de 12 à 23 mois très satisfaisante pour toutes les vaccinations [> 85%]. 3. Haut pourcentage d’enfants entre 12 et 23 mois complètement vaccinés [77,9% CI 95% : 71,2 – 84,6] 4. Faible rétention de la carte de vaccination et / ou la carte de vaccination non mise à jour. [souvent plusieurs cartes de vaccination pour le même enfant] 5. Les principaux motifs de non-vaccination sont liés à sont liés au manque d'opportunités [absence/voyage des enfants/parents] et d'obstacles [pas de poste de santé] 6. La principale source d'information sur la campagne de vaccination contre la rougeole menée en décembre 2018 était les relais communautaires [54%] 7. La couverture vaccinale contre la rougeole globale est de 94,1% [IC=91,5 – 96,6] et reste supérieure à 90% dans tous les groupes d’âge, à l’exception des enfants entre 9 et 11 mois.
  • Routine immediate eye examination at the point of care for diagnosis of AIDS-related Cytomegalovirus Retinitis among patients with a CD4-count < 100 in Myanmar

    Ei, WLSS; Soe, KP; Hilbig, A; Murray, J; Heiden, D (Oxford University Press, 2019-06-14)
    A retrospective review of diagnosis of cytomegalovirus retinitis (CMVR) before and after introduction of routine immediate eye examination among AIDS patient in Myanmar with an absolute CD4 T cell count <100 cells/microliter demonstrated an increased detection of CMVR from 1.1% (14/1233) to 10.7% (65/608), an improvement of approximately ten-fold. Diagnosis of CMVR was achieved a mean of 2 days after clinic enrollment.
  • Outcomes of patients enrolled in an antiretroviral adherence club with recent viral suppression after experiencing elevated viral loads

    Sharp, J; Wilkinson, L; Cox, V; Cragg, C; van Custem, G; Grimsrud, A (Health and Medical Publishing Group, 2019-06-11)
    Background: Eligibility for differentiated antiretroviral therapy (ART) delivery models has to date been limited to low-risk stable patients. Objectives: We examined the outcomes of patients who accessed their care and treatment through an ART adherence club (AC), a differentiated ART delivery model, immediately following receiving support to achieve viral suppression after experiencing elevated viral loads (VLs) at a high-burden ART clinic in Khayelitsha, South Africa. Methods: Beginning in February 2012, patients with VLs above 400 copies/mL either on firstor second-line regimens received a structured intervention developed for patients at risk of treatment failure. Patients who successfully suppressed either on the same regimen or after regimen switch were offered immediate enrolment in an AC facilitated by a lay community health worker. We conducted a retrospective cohort analysis of patients who enrolled in an AC directly after receiving suppression support. We analysed outcomes (retention in care, retention in AC care and viral rebound) using Kaplan–Meier methods with follow-up from October 2012 to June 2015. Results: A total of 165 patients were enrolled in an AC following suppression (81.8% female, median age 36.2 years). At the closure of the study, 119 patients (72.0%) were virally suppressed and 148 patients (89.0%) were retained in care. Six, 12 and 18 months after AC enrolment, retention in care was estimated at 98.0%, 95.0% and 89.0%, respectively. Viral suppression was estimated to be maintained by 90.0%, 84.0% and 75.0% of patients at 6, 12 and 18 months after AC enrolment, respectively. Conclusion: Our findings suggest that patients who struggled to achieve or maintain viral suppression in routine clinic care can have good retention and viral suppression outcomes in ACs, a differentiated ART delivery model, following suppression support.
  • Reproductive health in humanitarian settings in Lebanon and Iraq: results from four cross-sectional studies, 2014-2015.

    Balinska, MA; Nesbitt, R; Ghantous, Z; Ciglenecki, I; Staderini, N (BMC, 2019-06-10)
    BACKGROUND: Reproductive health is an important component of humanitarian response. Displaced women need access to family planning, antenatal care, and the presence of a skilled birth attendant at delivery. Since the beginning of the Syrian conflict in 2011, Lebanon and Iraq have been hosting large numbers of refugees, thereby straining local capacities to provide these services. In order to identify salient health needs, Médecins Sans Frontières conducted a survey in several sites hosting refugees and internally displaced persons across the region. Here we describe the reproductive health profile of Syrian refugees, Iraqi displaced persons, and vulnerable Lebanese and their use of services. METHODS: We conducted four cross-sectional surveys in 2014-2015 in two sites in Lebanon and two sites in Iraq. Depending on the site, two-stage cluster sampling or systematic sampling was intended, but non-probability methods were employed at the second stage due to implementation challenges. We collected information on overall health (including reproductive health) and demographic information from heads of households on the basis of a standardized questionnaire. Pearson chi-square tests were used to compare proportions, and generalized linear models were used to calculate odds ratios with regard to risk factors. All analyses were performed using the survey suite of commands in Stata version 14.1. RESULTS: A total of 23,604 individuals were surveyed, including 5925 women of childbearing age. Overall, it was reported that 7.5% of women were currently pregnant and 12.8% had given birth within the previous 12 months. It was reported that pregnancy was unplanned for 57% of currently pregnant women and 66.7% of women who had delivered in the previous year. A slight majority of women from both groups had accessed antenatal care at least once. Amongst women who had delivered in the previous year, 84.5% had done so with a skilled birth attendant and 22.1% had had a cesarean section. Location and head of household education were predictors of unplanned pregnancy in multivariable analysis. Head of household education was also significantly associated with higher uptake of antenatal care. CONCLUSIONS: Considering the large number of pregnant women and women having recently delivered in these settings, addressing their sexual and reproductive health needs emerges as a crucial aspect of humanitarian response. This study identified unmet needs for family planning and high cesarean section rates at all sites, suggesting both lack of access to certain services (contraception, antenatal care), but also over-recourse to cesarean section. These specific challenges can impact directly on maternal and child health and need today to be kept high on the humanitarian agenda.
  • Severe acute malnutrition results in lower lumefantrine exposure in children treated with artemether-lumefantrine for uncomplicated malaria

    Chotsiri, P; Denoeud-Ndam, L; Baudin, E; Guindo, O; Diawara, H; Attaher, O; Smit, M; Guerin, PJ; Duombo, OK; Weisner, L; Barnes, KI; Hoglund, RM; Dicko, A; Etard, JF; Tarning, J (American Society for Clinical Pharmacology and Therapeutics, 2019-06-01)
    Severe acute malnutrition (SAM) has been reported to be associated with increased malaria morbidity in Sub‐Saharan African children and may affect the pharmacology of antimalarial drugs. This population pharmacokinetic‐pharmacodynamic study included 131 SAM and 266 non‐SAM children administered artemether‐lumefantrine twice daily for 3 days. Lumefantrine capillary plasma concentrations were adequately described by two transit‐absorption compartments followed by two distribution compartments. Allometrically scaled body weight and an enzymatic maturation effect were included in the pharmacokinetic model. Mid‐upper arm circumference (MUAC) was associated with decreased absorption of lumefantrine (25.4% decrease per 1 cm reduction). Risk of recurrent malaria episodes (i.e. reinfection) were characterised by an interval‐censored time‐to‐event model with a sigmoid EMAX‐model describing the effect of lumefantrine. SAM children were at risk of under‐exposure to lumefantrine and an increased risk of malaria reinfection compared to well‐nourished children. Research on optimised regimens should be considered for malaria treatment in malnourished children.

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